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Change request 10254 releases the 2018 furnishing fee for services related to the administration of clotting factors to Medicare beneficiaries. [MM10254]
This special edition article releases information regarding Office of Inspector General (OIG) reports, which focused on claims for right heart catheterizations with heart biopsies that used modifier 59 and claims for 96 or more continuous hours of mechanical ventilation. [SE17017]
The Centers for Medicare & Medicaid Services (CMS) recently announced it will release, in December, the 2018 annual update of Healthcare Common Procedure Coding System (HCPCS) codes for skilled nursing facility consolidated billing. [MM10262]
All Medicare physicians, providers, and suppliers who offer services and supplies to qualified Medicare beneficiaries (QMB) may not bill QMBs for Medicare cost-sharing. This article was revised on August 23 to highlight upcoming system changes that identify the QMB status of beneficiaries and exemption from Medicare cost-sharing, recommend key ways to promote compliance with QMB billing rules, and remind certain types of providers that they may seek reimbursement for unpaid deductible and coinsurance amounts as a Medicare bad debt. [SE1128]
Modifiers that identify the manufacturer of a biosimilar biological product are required on Part B claims. The assignment of modifiers to specific codes is updated quarterly.
Change request (CR) 9911 releases information regarding the qualified Medicare beneficiary (QMB) indicator that modifies the Medicare claim processing systems to help providers more readily identify the QMB status of each patient. This article was revised July 24 to add links to related MLN Matters articles SE1128 and MM9817. [MM9911]
Change request 10044 provides instruction to Medicare administrative contractors to implement two new benefit enhancements for performance year three of the next generation accountable care organization (NGACO) model. [MM10044]
The Centers for Medicare & Medicaid Services (CMS) recently updated the list of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing provision of the skilled nursing facility (SNF) prospective payment system. [MM10163]
First Coast implemented a pre-payment edit on April 16, 2012, that applies to office visit E/M claims (codes 99201-99205 and 99212-99215) billed with the 24 modifier.
This article reviews specific points that providers should consider regarding CCM guidelines, along with a link to a Medicare Learning Network® (MLN®) article that outlines the CCM guidelines in more detail.
CMS has revised the ABN form effective June 21, 2017. The new form is mandatory after a 60-day transition period.
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
This information outlines the process for the 935 recoupment.
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 2.375 percent is in effect, from July 1, 2017, through December 31, 2017. [Publication 100-04, Chapter 1, Section 80.2.2]
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
To correct claims returned for beneficiary name and number mismatch, take the following action. [CR 7260]
To determine if a claim was medically reviewed, providers should look at certain fields on the claim screen. [Provider Outreach and Education]
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9410]
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2017 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9902]
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.